Q&A: Update on mifepristone availability

Dr. Sarah Prager, a UW Medicine OB-GYN, offers context to the recent U.S. Supreme Court decision, which ordered that mifepristone remain available in the United States while legal challenges work their way through the federal courts. Here is that discussion.

Q: What is mifepristone and how does it work?

Prager: Mifepristone works as a progesterone blocker. Without progesterone, the lining of the uterus breaks down and the pregnancy doesn’t continue. The second medicine, misoprostol, makes the uterus contract.

Q: Can I still get mifepristone in Washington state?

Prager: Yes, as of right now, there is access to mifepristone for patients in need of this drug for abortion or miscarriage care.  

Q: Can I get it via telehealth? Or do I have to see a doctor in person?

Prager: There are some clinical sites locally which are supplying telehealth, such as Planned Parenthood clinics in Washington, as well as the Cedar River Clinics in Renton. UW Medicine does not offer telehealth visits for medication abortions yet, but we hope to provide these services starting in June of this year. But for now, you have to go to a clinic and see a doctor or nurse at UW Medicine sites.

Q: Can a faculty member or UW clinician dispense an abortion-inducing medication across state lines to a patient in a state that makes abortion illegal? 

Prager:  No. If a state prohibits abortion by medication, faculty and UW employees must abide by the laws of that state when treating a patient who is physically present in that state.

Q: Can a faculty member or UW clinician dispense an abortion-inducing medication to a patient located in Washington, or who came to Washington to receive abortion services?

Prager:  Yes. Washington law allows Washington clinicians to provide abortion services to patients who are located in Washington, regardless of what state they live in. A patient presenting in Washington for services may be treated in Washington, consistent with the laws of Washington. Faculty must dispense abortion inducing medication in Washington and only issue the prescriptions to pharmacies located in Washington.

Our recommendation to patients is that the drugs should be taken in Washington before returning to their home state. If there is a complication, it is preferable for them to still be in a state where abortion is legal.

Q: What do we need to know about post-abortion care?

Prager:  While complications from abortion or miscarriage are rare, conditions such as retained pregnancy tissue in the uterus, bleeding and infection can occur. It is critical for patients seeking post-abortion care services to be treated with care and dignity and to have their medical issues addressed upon presentation.

Post-abortion care may happen in a clinic or an emergency department setting and includes: managing residual side effects or complications of abortion, emotional support, and providing comprehensive birth control services without discrimination or coercion.

 UW Medicine provides confidential post-abortion care; patient information remains private for post-abortion care services in the same way other services remain private. It is generally not necessary for patients to disclose that they have had an abortion. Moreover, healthcare professionals are unable to determine whether the complications occur from abortion or miscarriage.

The real take-home for me, is that post-abortion care hasn’t changed. We still need to be providing comprehensive care for miscarriage or an abortion. There is no way for clinicians to know the difference, so let’s treat patients with respect in providing this care.

Q: How available is the second drug in the regimen, misoprostol, if mifepristone is banned?

Prager:  Misoprostol is widely available and will likely stay that way. Part of reason why mifepristone is targeted for court challenges and bans is that its only FDA [Food and Drug Administration] approval is for use in medication abortion. Misoprostol was approved by the FDA for treating stomach ulcers, and is used off-label for other medical treatments including abortion. Therefore it’s much more difficult to attack misoprostol in the courts or with the FDA.

Q: What is the difference between the two-drug regimen and taking only misoprostol? Is the efficacy different? How does the patient experience differ?

Prager: There are two main differences if you switch from the two-drug regimen to the one-drug regimen using only misoprostol.

When you use mifepristone prior to using the misoprostol, there are exceptionally good success rates, and it helps to minimize side effects. The success rates with mifepristone/misoprostol regimen are about 95% to 98%, and about 78% with a single dose of misoprostol. With multiple doses of misoprostol, the success rate increases to approximately 95%. 

When you just use misoprostol, patients have to take more doses of the misoprostol, which increases the side effects such as cramping, gastrointestinal distress, vomiting and diarrhea. Repeated doses of misoprostol mean prolonging the amount of time that somebody is potentially experiencing these side effects.The patient may worry and wonder if they have to go to an emergency department, whether or not they clinically need to do so. It also could potentially increase their need for more pain medications. You might see more patients requesting narcotic medications, and we don't typically need pain meds for medication abortion. So it really just punishes pregnant people for having a miscarriage or an abortion.  

A misoprostol-only regimen is eliminating an evidence-based best practice tool for healthcare providers. Mifepristone has been approved by the FDA for 23 years and has been shown in numerous clinical studies to be both safe and effective.

Q: What advice would you give to pregnant women traveling in the U.S. at this time?

Prager: For anyone who is pregnant, I would be cautious traveling to states where abortion is illegal. In these states, there are a number of pregnancy complications that may not be managed in an evidence-based way that supports the health of the pregnant person. Most people will not experience pregnancy complications while traveling, however this can be something factored into travel decisions. 

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